P954: MULTIPLE MYELOMA IN LATIN AMERICA CANCER REGISTRY: THE MYLACRE STUDY
Authors: Vania Hungria, Rafael Gaiolla, Kenny Galvez, Guillermina Remaggi, Natalia Schutz, Rosane Bittencourt, Angelo Maiolino, Guillermo Quintero, Maria Silvana Cugliari, Walter Moises Tobias, Carolina Colaco Villarim, Edvan Crusoe, Alicia Ines Enrico, Huiling Pei, Mariana Fernandez, Jaqueline Saes, Damila Trufelli
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: The treatment landscape of Multiple Myeloma (MM) has evolved in the last decade with the approval of many drugs with different mechanisms of action, improving patient survival1. However, in low-resource regions such as Latin America (LA), the approval and access to novel therapies might be delayed, negatively impacting the outcomes of those patients2. Aims: The MYLACRE study aimed to describe the MM population concerning demographics and clinical characteristics and to profile the treatment landscape of LA MM patients. Methods: This was a retrospective and prospective non-interventional, multicenter study of MM patients treated at reference centers of 5 LA countries. Patients aged ≥ 18 diagnosed with MM between January 1, 2016 and June 30, 2021 were included. Data were extracted from patient´s medical charts between August 2019 and June 2022 and a descriptive analysis was conducted. Results: A total of 1,029 patients from 22 reference centers were enrolled, with a median follow-up of 26.8 months. Two thirds (66.8%) had private health insurance coverage. The median age at diagnosis was 64 years and most of the patients were diagnosed as International Staging System (ISS) stage III (44%). End-organ damage signs and symptoms at diagnosis were reported in most of the patients, with half of them (45.2%) presenting anemia, 12.7% hypercalcemia, 22% renal disfunction and 80.2% bone lesions. Approximately 60% of the patients underwent a cytogenetic test and, of these, one-third (27%) had a cytogenetic abnormality (32% translocation 4;14, 14% translocation 11;14, 20% translocation 14;16, 14% 1q amplification, 37% 17p deletion, 41% other). From the enrolled patients, 1,003 started the first line of therapy (LOT), 405 LOT2, 168 LOT3, 74 LOT4 and 20 LOT5, resulting in an attrition rate of approximately 23-34% from one LOT to the subsequent LOT. The majority of patients (69.9%) were eligible for stem cell transplant (SCT) upfront, but, of those, 26.8% did not receive it and the main reason was insufficient response, disease progression or death before SCT. Considering patients who underwent SCT, the majority in both private and public settings received a proteasome inhibitor (PI)-based therapy and considering those who did not undergo SCT, the majority in the private setting received a PI-based therapy, while in the public setting the majority received an immunomodulatory drug (IMiD) based therapy. The distribution of different regimens by LOT and by health insurance status is described in Table 1. The median progression-free survival (PFS) of LOT1 was 40 months (70 months for patients who underwent SCT and 19.7 months for non-SCT patients). For LOT2, the median PFS was 15.9 months, for LOT3 was 8.9 months, and for later LOT was 4.6 months. The median overall survival (OS) for all patients was 48.9 months. Summary/Conclusion: The attrition rate between subsequent LOTs is high and the pattern of treatment differs between private and public settings. The adoption of novel therapies in LA is still low compared with other regions in the world, and the unmet need is higher in earlier LOTs and for patients with no health insurance. REFERENCES: 1.Bobin A, Leleu X. Recent advances in the treatment of multiple myeloma: a brief review. Fac Rev. 2022 Sep 29;11:28. 2.Tietsche de Moraes Hungria V, Chiattone C, Pavlovsky M, et al. Epidemiology of Hematologic Malignancies in Real-World Settings: Findings From the Hemato-Oncology Latin America Observational Registry Study. J Glob Oncol. 2019 Nov;5:1-19.Keywords: Epidemiology, Diagnosis, Treatment, Multiple myeloma